Conditions & Treatments

Allergic Rhinitis (Allergies)

Rhinitis is a reaction that occurs in the nose when airborne irritants (allergens) trigger the release of histamine. Histamine causes inflammation and fluid production in the fragile linings of nasal passages, sinuses, and eyelids.

Allergic Rhinitis

What is allergic rhinitis?

Rhinitis is a reaction that occurs in the nose when airborne irritants (allergens) trigger the release of histamine. Histamine causes itching, inflammation, and fluid or mucous production in the fragile linings of nasal passages, sinuses, and eyelids.

There is usually a family history of allergic rhinitis.

What are the types of allergic rhinitis?

The two categories of allergic rhinitis include:

Seasonal. This type occurs particularly during pollen seasons.

Perennial. This type occurs throughout the year and is commonly seen in younger children.

What are the causes of allergic rhinitis?

The most common causes of allergic rhinitis include the following:

Pollen (for example, tree, grass, or weed)

Dust mites

Mold

Cockroach droppings

Animal dander

Tobacco smoke

What are the symptoms of allergic rhinitis?

The following are the most common symptoms of allergic rhinitis. However, each child may experience symptoms differently. Symptoms may include:

Sneezing

Congestion

Runny nose

Itchy nose, throat, eyes, and ears

Nosebleeds

Clear drainage from the nose

Children with perennial allergic rhinitis may also have the following:

Recurrent ear infections

Snoring

Breathing through the mouth

Poor performance in school

"Allergic salute." This is when a child rubs his or her hand upward across the bridge of the nose while sniffing. This may cause a line or crease to form across the bridge of the nose.

The symptoms of allergic rhinitis may resemble other conditions or medical problems. Always consult your child's health care provider for a diagnosis.

How is allergic rhinitis diagnosed?

Typically, the diagnosis is made by your child's health care provider based on a thorough medical history and physical examination. In addition to the above symptoms, your child's health care provider may find, on physical examination, dark circles under the eyes, creases under the eyes, and swollen tissue inside the nose. If this is the case, then your child's doctor may refer your child to see an allergist. An allergist is a specialist who is trained to perform allergy skin testing, which will tell you exactly what environmental aeroallergens cause allergic symptoms in your child.

Treatment for allergic rhinitis

Specific treatment for allergic rhinitis will be determined by your child's health care provider based on:

Avoidance of the allergens. Avoidance of the allergens that are causing the problem is the best treatment.

Traditional antihistamines. Antihistamines help to decrease the release of histamine, possibly decreasing the symptoms of itching, sneezing, or runny nose. Some examples of antihistamines are diphenhydramine (Benadryl) or hydroxyzine (Atarax). These medications may cause drowsiness. Consult your child's health care provider to determine the proper dosage for your child.

Nonsedating antihistamines. Nonsedating antihistamines are also antihistamines but without the side effect of drowsiness. Nonsedating antihistamines may include cetirizine (Zyrtec), loratadine (Claritin), or fexofenadine (Allegra). Consult your child's health care provider to determine the proper dosage for your child.

Corticosteroid nasal sprays. Corticosteroid nasal sprays also help to decrease the swelling in the nose. Corticosteroid nasal sprays work best when used before the symptoms start, but can also be used during a flare-up. Consult your child's health care provider to determine the proper dosage for your child.

Anti-leukotrienes. These are a relatively new type of medication being used to control the symptoms of asthma and allergic rhinitis. These medications help to decrease congestion in the chest and nose and are usually given by mouth.

Note: Talk with your child's health care provider before giving a decongestant to help relieve his or her symptoms.

If your child does not respond to avoidance or to the above medications, your child's allergist then may recommend immunotherapy based on the findings. Immunotherapy usually involves a three- to five-year course of repeated injections of specific allergens to decrease the reaction to these allergens when your child comes into contact with them. Consult your child's health care provider for more information.

How is allergic rhinitis prevented?

Preventive measures for avoiding allergic rhinitis include:

Environmental controls, such as air conditioning, during pollen season

Avoiding areas where there is heavy dust, mites, molds

Avoiding pets

The link between allergic rhinitis and asthma

Controlling asthma may mean controlling allergic rhinitis in some patients, according to allergy and asthma experts. Allergic rhinitis is a common problem that may be associated with asthma.

Guidelines from the World Health Organization recognize the link between allergic rhinitis and asthma. Although the link is not fully understood, one theory asserts that rhinitis makes it difficult to breathe through the nose, which hampers the normal function of the nose. Breathing through the mouth does not warm the air, or filter or humidify it before it enters the lungs, which can make asthma worse.

Treatment Programs

Massachusetts General Hospital understands that a variety of factors influence patients' health care decisions. That's just one reason why we're dedicated to ensuring patients understand their diagnosis and treatment options. Because a single option might not serve all patients, we offer a wide range of coordinated treatments and related services across the hospital. Patients should consult with their primary care doctor or other qualified health care provider for medical advice and diagnosis information.

Seasonal, Perennial and Environmental Allergies ProgramThe Massachusetts General Hospital Seasonal, Perennial and Environmental Allergies Program provides specialized care and the latest therapies to patients with rhinitis and other allergies so they can enjoy a better quality of life.

Asthma ProgramThe Massachusetts General Hospital Asthma Program diagnoses and manages asthma in adults and children, and provides ongoing care to help patients effectively control their condition and enjoy a better quality of life.